Large Left Coronary Artery to Right Ventricular Fistula in A Paedi atric Patient: A Watchful Approach and Successful Closure Utilising  Modern Imaging Modalitie

Ibtihalat Mohamed,=; Greg Murphy; Steve Shipton; Deane Yim

Authors

Ibtihalat Mohamed,= Paediatric Cardiology Department, Perth Children’s Hospital, Perth, WA, Australia Author
Greg Murphy Paediatric Cardiology Department, Perth Children’s Hospital, Perth, WA, Australia Author
Steve Shipton Paediatric Cardiology Department, Perth Children’s Hospital, Perth, WA, Australia Author
Deane Yim Paediatric Cardiology Department, Perth Children’s Hospital, Perth, WA, Australia Author

Keywords:

Coronary artery fistula, catheterisation, trans-catheter embolization, percutaneous, congenital heart disease

Abstract

Graphical abstract

Background: Coronary artery fistulae are rare anomalies with an incidence of 0.2-1.3%. Management for symptomatic pa
tients is clearly defined, however; in asymptomatic patients, indications and timing for intervention as well as suitable type of
intervention remains debated. Case presentation: We describe a 3 months old male infant referred with an asymptomatic systolic murmur. The infant diagnosed with a large left coronary artery fistula communicating with the right ventricle. On serial review; the infant showed evidence of progressive left heart volume loading on the transthoracic echocardiogram, by 15 months of age.
Computed tomography was integral to pre-operative planning. The fistula was uneventfully closed by percutaneous trans-cath
eter embolization using an 8x7mm second generation Amplatzer® vascular plug. Follow up angiography and echocardiogram showed no residual flow. Conclusion: We describe a toddler presenting in infancy who underwent successful transcatheter closure of a large left coronary artery to right ventricular fistula, following an initial conservative management approach. Left-sided volume loading was
alleviated following percutaneous closure. Pre-operative imaging facilitated successful planning and closure.

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